Excerpt from Mitch\'s new book "Healthcare Babylon: A Decade of Commentary & Opinion from The Chronicle of Healthcare Marketing" More at http://www.healthcarebabylon.biz

1. Re-thinking universal healthcare
C
anadians, when asked, say they define the
country’s national character primarily
through the social programs offered
through its government, such as universal
7 Canadians, when asked, say
healthcare.
the greatest of their countrymen was the late T.C. Douglas,
the acclaimed proponent of universal healthcare.
It seems many of our citizens have firm and fixed views
on the subject of Medicare, which makes it more than a bit
challenging to engage in an open-minded discussion of the
sustainability of this concept in the 21st century.
Nonetheless, it is our responsibility to report the news that
“We Got Health Coverage” is not much of a basis for a nation-
al identity, or, for that matter, even the identity of a storefront
insurance office. Medicare, a nice idea, does not a great nation
make. Tommy Douglas, a nice man*, was no Simon Bolivar.
Whichever mush-headed jackass it was who told you that uni-
versal healthcare was a sacrosanct subject that no patriot
should ever scrutinize—well, that fellow was mistaken.
* Nice as all get out, even if he did argue heartlessly in his sociology MA
thesis from McMaster University for the “sterilization of the mentally
and physically defective.” Well, the defectives would have been pleased
that at least their operations would have been covered by Medicare.

2. HEALTHCARE BABYLON
22
That fellow may have been Roy Romanow, the head of the
Commission on the Future of Health Care in Canada. Three
years ago, Romanow and his researchers studied our broken
and dysfunctional national health system, and concluded that
throwing another $15 billion toward the problem would solve
everything by 2006.
It was a quaint idea then, when the phrase “wait-time cri-
sis” was just beginning to find its way into everyday dis-
course. Now that 2006 has arrived, and medical case-loads
have backed up ever further, and communities have seen
their access to care further reduced, and costs have become
even more unmanageable, Romanow’s earnest suggestions
seem the product of a disengaged mind.
But former Prime Minister Paul Martin, during his brief
reign, found it politically expedient to parrot the lingo of the
Romanow Report. Opening the 37th Parliament, he said his
government accepted “one fundamental tenet: that every
Canadian have timely access to quality care, regardless of
income or geography—access when they need it.”
Prime Minister Martin, of course, could not deliver on this
absurd promise. He may take some comfort, during the com-
ing years of his forced retirement, in admitting that no one
can. Access to care, like any other specialized service or high-
priced commodity, is not infinitely expandable and must be
rationed. The challenge is to provide distribution in a manner
that is democratic, compassionate, fiscally responsible and
humane. It is unconscionable that politicians would proclaim
that every citizen in every community would have equal
opportunity to benefit from every available medical proce-
dure under every circumstance. To encourage such expecta-
tion is to mislead citizens who may be in desperate need.

3. The Permanent Healthcare Crisis 23
It is a disgraceful thing to do for political purposes: to
maintain that, yes, you have health coverage, but, no, you’ll
have to wait a year for your diagnostic procedure. Or, no, we
won’t be paying for the therapy for your mother’s catastroph-
ic illness. Or, sorry, but your wife will have to travel to
Michigan for her breast cancer treatment. Or, yes, you are
entitled to the finest care available, but, no, you may not be
able to find a family doctor who will accept you as a patient.
There is now a new federal government in Canada. It
needs to tackle the rising challenge of providing an acceptable
level of healthcare for Canadians. The new government, like
its predecessor, will not be able to provide timely organ trans-
plants for every citizen in need, nor can it offer residents of
remote areas ready access to the most sophisticated technolo-
gy, nor can it likely afford to fund, in every instance where it
may be beneficial, new therapeutic regimens which cost
$40,000 annually.
We wish it were otherwise. It isn’t, and the time has
arrived when our leaders must finally level with us.
Tony Clement, the incoming Health Minister, has an
opportunity to quickly address this issue.
He will need to assemble a reform-minded coalition of his
provincial colleagues, physician and patient groups, third-
party payers, the pharma industry, and lay opinion leaders.
He will need to assess potentially contentious concepts such
as amending the Canada Health Act to allow the existence of
for-profit clinics, but imposing a significant tax on such pri-
vate-sector initiatives, to be used directly for the expansion of
public care. Out of necessity, he may need to follow the
Oregon model of restricting universal access to an arbitrary
list of 300 or fewer conditions. He may wish to consider the

4. HEALTHCARE BABYLON
24
reassignment of certain functions traditionally carried out by
Health Canada, potentially to a hypothetical North American
Medicines Evaluation Agency, modelled after that established
by the European Union.
In short, he will need to be much more resourceful and
less restricted by ideology than his predecessors, if universal
healthcare is to survive in any form. It now seems obvious
that Medicare’s increasing inability to honor its commitments
will soon pose as much a threat to peace, order and stable
governance as did the Great Depression of the 1930s. As part
of his unenviable job, Minister Clement will be required to
first acknowledge and then begin the process of coming to
terms with this reality.*
February 2006
* He hasn’t.